Direct primary care reduces inefficiency and costs to increase the time doctors spend with patients
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Do you wish you had died when you think about the cost of insurance, your co-pay and medications? Do you wish that you were dead when you consider the cost of your insurance, co-pays, and medication? The American healthcare system is in crisis. Insurance costs are increasing. Costs of prescription drugs and treatment are increasing. It is only the amount of time that doctors spend with their patients that has decreased. That is due to the declining number of primary care doctors, increased paperwork, dealing with insurance companies and the incentives for churning through a high volume of patients.
Direct Primary Care
Enter direct primary care (DPC). The model of direct primary care (DPC) removes health insurance companies from patient care, and reduces the paperwork. Gayle Brekke is the
chief influencer at Primary Care Mindset
.“It’s a relationship,” Brekke said, that harkens back to how family doctors operated in the first half of last century. She is chief influencer at Primary Care Mindset
.
“It’s a relationship,” Brekke said, that harkens back to the way family doctors operated in the first half of the last century.
“That’s what a lot of people and DPC physicians say,” according to Brekke. According to PubMed’s publication, AMN/Merritt Hawkins, it takes on average 26 days for a patient to see a doctor for a
examination lasting 18 minutes. DPC practices also have longer doctor visits – up to 60 minutes. Brekke says DPC doctors have an incentive for doing more work than traditional practices because they have the time. “A DPC can get on top of a medical condition quicker because a patient can get in to see them quicker.”Reduced Paperwork And Insurance InefficiencyThe most burdensome challenges of doctors and staff in conventional practices are high patient volume, keyboarding electronic health records, and fighting insurance companies.By removing health insurance companies from the patient-doctor relationship, DPC physicians reduce the time they spend on administrative tasks. Brekke says that it also reduces administrative staff. “It is not uncommon for a DPC office to have a part-time administrator.” “There are an average of 2.5 administrative people for each physician in traditional medicine.”
Instead of insurance, patients pay a monthly, quarterly or annual fee for unlimited primary care. The fees vary depending on the location but can be as low as $80.00 per month. In addition to examinations and treatment, patient care may include consultations, care management and coordination as well as clinical and lab services.
As a result, doctors and staff have more time to focus on patient care, because they no longer have to spend time billing insurance companies for payment, seeking prior authorization and coding.
Reduced Patient Volume
In addition, DPC practices limit the number of patients they care for.
“DPC doctors take care of far fewer patients than traditional practices,” says Brekke. A DPC doctor may have 400 patients. The DPC model allows doctors to spend more time with their patients and provides better care for them. That means doctors have more time with their patients and their patients are better cared for in the DPC model.”
Patients also have greater access to their doctors through phone calls, text and email. In addition, many dpc practices dispense medications. Dpc doctors also build relationships with specialists and labs that reduce costs for their patients. They are designated direct care specialists (DCS). Brekke said that DPC is divided into two buckets. “You have one bucket for individuals and you have another for small companies.”
An employer with a handful of employees can offer DPC coverage for a fraction of the cost of a major medical plan. Major medical insurance does cover more than DPC. However, most small businesses with a limited workforce can not afford to offer the coverage.
Overburdened Doctors
In a 2023 Time Magazine Op-Ed, a Stanford University School of Medicine physician sounded an alarm about the demands doctors face that are not directly related to patient care.
“Doctors today spend two hours doing computer tasks for every one hour facing patients,” wrote Dr. Ilana Yurkiewicz. She is both a primary care doctor and an oncologist.
That jives with previous research published in PubMed.
“During the office day,
physicians spent 27 percent of their total time on direct clinical face time with patients
and 49.2 percent of their time on EHR (Electronic Health Records) and desk work,” a 2016 study found.
“In an era where multibillion dollar software promises to ease data-sharing, the process for providers to input and find health data remains manual, labor intensive, and error prone,” wrote Dr. Yurkiewicz.
“Our current solution to these technologic glitches is leaning on people to serve the needs of the electronic charts. The reverse was intended. It is often the doctors who are responsible for fixing logistical problems. Recently I prescribed a medication that took 22 clicks, waiting on hold with an insurance company, tracking down a denial letter, writing an appeal, documenting all these phone calls, and keeping my patient apprised through messaging.”
Doctor’s Off Boarding
Most doctors did not pursue a career in medicine to shuffle electronic paperwork and arm wrestle with insurance companies. The modern medical practice is time-consuming and tedious. As a result, the number of doctors leaving medicine is steadily growing.
“The percentage of U.S. doctors in
adult primary care has been declining
for years and is now about 25% — a tipping point beyond which many Americans won’t be able to find a family doctor at all,” according to a KFF report.
The
number of primary care physicians per capita declined
from 68.4 per 100,000 people in 2012 to 67.2 per 100,000 people in 2021. At the same time, Canada, which has national healthcare, had a ratio of 133 primary care physicians per 100,000 people.
By 2037, the
National Center for Health Workforce Analysis (NWCA) projects there will be a shortage of 87,150 primary care physicians.Currently, over 100 million Americans don’t have usual
access to primary care, a number that has nearly doubled since 2014. The same month Dr.
Yurkiewicz’s piece appeared, Dr. Jesse M. Ehrenfeld, then president of the American Medical Association, spotlighted physician burnout in an address to the National Press Club. He described the trend as “an underlying crisis in medicine today which is having a profound effect on our ability care for patients.” Ehrenfeld emphasized that the problem is nationwide.“The physician shortage that we have long feared–and warned was on the horizon–is already here. Ehrenfeld said that the crisis is urgent and that it affects every part of the country, urban and rural. Families with limited resources and high needs are most affected. Ehrenfeld mentioned several doctors that he personally knew who had quit their practices or suffered a mental breakdown. The most touching story was about a friend he had known for many years:
“Two year ago, my friend and classmate from medical school, an emergency department physician in California, who tirelessly worked on the frontlines of COVID, committed suicide. He was a loving and energetic soul, a brilliant doctor who cared for others and felt the burden of the pandemic. He tried to pull himself out of it. He didn’t even know how to ask for help. And he didn’t know how to ask for help.“I am still deeply troubled by his death, just as I am haunted knowing there are thousands of people in his community who can no longer receive his care.”Whether you are a doctor wanting to learn more about direct patient care or a patient looking for a direct patient care practice near you, check the following link:
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